1. Introduction

Repetitive stress injuries bring misery to many pianists. They
are very common, and the pain they cause can be dreadful. The
list of famous pianists with injuries is much longer than most
people think--it includes Gary Graffman, Leon Fleisher, Wanda
Landowska, Artur Schnabel, Alexander Scriabin, Ignaz Friedman,
Sergei Rachmaninoff, Clara Schumann, Glenn Gould, Michel Beroff,
Richard Goode and many others. In most cases the injury did not
end the career, but it forced cancellations of concerts or tours,
or restriction of repertoire. This is a tragic situation, since
injuries are preventable and curable. Unfortunately, the literature
I have seen on pianist's injuries does not clearly explain how
injuries are caused, and some of the most commonly recommended
"cures" are band-aids: they are good in themselves and
helpful up to a point but they do not remove the cause of the
injury. In this paper I shall briefly describe the causes of pianists'
injuries and then indicate what has to happen to permit an injured
pianist to recover. I believe that every pianist and teacher should
have this information, since injuries can lead to permanent damage
if left untreated.

Injuries are caused by stressful movement.

Our hands and arms can move in many ways, but some ways of moving
put extra stress on the tendons and other soft tissues. If a person
moves in a stressful way, and does this repeatedly over a long
period of time, the vulnerable structures may be injured. In this
paper, I shall use the terms "efficient movement" or
"stress-free movement" to refer to ways of moving that
can be used even in highly repetitive tasks without causing injury.
Which ways of moving are "efficient" or "stress-free"
in this sense is a matter of anatomical fact, not of conscious
awareness. Conscious awareness tells us whether a particular movement
hurts right now, but it does not tell us whether that same movement
repeated millions of times over a period of years would lead to
injury. Note also that the stressfulness of a movement is not
just a matter of position or outward appearance. A movement can
appear right without being right (because of underlying tensions
that the eye cannot see); conversely (but less often) it can look
wrong without being stressful.

"Tom has the ability to immediately identify unproductive
and even hurtful use of the body mechanism in playing
the piano. After working with him I am now immediately
aware of tension in my body and can eliminate it before
it causes pain. Tom is very creative and will work with
a pianist until a favorable outcome is achieved."